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Biomedical subjects

X Le Coutour

Publications and source records attributed to X Le Coutour.

At least 19 recordsLinked to original sources
PubMed2006

Clinical evaluation of a screen pneumotachograph as an in-line filter.

The American Thoracic Society/European Respiratory Society Task Force underlined that the use of in-line filters during respiratory function tests "is an area of controversy". The aim of the present study was to measure the contamination occurring during forced expiration downstream from a screen pneumotachograph (SP) with and without an in-line filter (Pall PF30S). A total of 40 healthy subjects performed eight consecutive maximal expiratory manoeuvres into four sterile apparatuses (A1: no filter, no SP; A2: filter-only; A3: SP-only; A4: filter and SP) in random order. A blood agar plate was fixed downstream from the apparatus. Colony-forming units (CFUs) were counted after 24 h incubation at 37 degrees C. Of the 40 plates obtained with each apparatus, 13 were sterile with A1 (range 0-679 CFUs), 25 with A2 (0-49 CFUs), 30 with A3 (0-35 CFUs) and 39 with A4 (one CFU in the only positive plate). A1 versus A2 and also A3 versus A4 gave different values for the CFU number, but A2 and A3 showed similar contamination levels. The authors conclude that: 1) the in-line filter does not perform better than a screen pneumotachograph; 2) it does not eliminate the need to decontaminate the pneumotachograph; and 3) equipment placed downstream from an in-line filter and a screen pneumotachograph is almost protected from contamination.

Cross Infection↗
PubMed2002

Use of censored data to monitor surgical-site infections.

OBJECTIVE: To take into account the proportion of patients lost to follow-up when calculating surgical-site infection (SSI) rates. DESIGN: A multicenter SSI monitoring network in Basse-Normandie, France, using the definitions for SSI of the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. PATIENTS: Between January 1, 1998, and December 31, 1999, 3,705 patients were operated on in 25 units of 10 institutions. RESULTS: Of the patients, 41.2% (range, 5.1% to 95.5%) were seen 30 days or more after their operation. The global SSI attack rate was 2.19% (95% confidence interval, 1.72% to 2.66%). With the use of the Kaplan-Meier method, the incidence rate was 3.11% (95% confidence interval, 3.06% to 3.16%). The difference between the attack rate and the Kaplan-Meier incidence rate for each unit varied according to the percentage of patients seen on or after day 30 postoperatively and the number of SSIs diagnosed in patients seen on or after day 30. CONCLUSIONS: Practice guidelines are needed for the international monitoring for postdischarge SSIs and the calculation of SSI rates. The proportion of patients seen 30 days after their operation is a major quality criterion for SSI monitoring and should be routinely given in monitoring reports, oral communications, and publications to compare results obtained by different teams

Cross Infection↗
PubMed2000

Randomized multi-centre trial of the effects of a catheter coated with hydrogel and silver salts on the incidence of hospital-acquired urinary tract infections.

Catheters coated with hydrogel and silver salts have been proposed to prevent hospital-acquired urinary tract infections (UTI). We carried out a randomized, prospective, double-blind multi-centre trial to compare those catheters with classical urinary tract catheters. We included in the study 199 patients requiring urethral catheterization for more than three days: 109 in group 1 (classical catheter) and 90 in group 2 (catheter coated with hydrogel and silver salts). Urine from the patients was tested for 10 days after the insertion of the catheter (reactive dipsticks each day and diagnostic urinalysis every two days). The UTI associated with catheterization was defined on the basis of bacterial and cytological criteria (>10(5)cfu bacteria per mL and >10 leucocytes per mm(3)). Twenty-two UTIs were recorded: 13 in group 1 and nine in group 2. The cumulative incidence of UTI associated with catheterization was 11.1% overall, 11.9% for group 1 and 10% for group 2; the odds ratio was 0.82 (95% confidence interval: 0.30 to 2. 20); the cumulative incidence for UTI, calculated by the Kaplan-Meier method was 36.3 overall, 35.2 in group 1 and 36.0 in group 2; the overall incidence density was 19 per thousand days of catheterization, 21 in group 1 and 18 in group 2. The differences between the two groups were not significant. Overall, we feel that there is not enough evidence to conclude that catheters coated with silver salts and hydrogel give greater protection than classical catheters and to recommend widespread use.

Coated Materials, Biocompatible↗
PubMed1994

[Nosocomial risk].

The risks of hospital-acquired infection were, for many years, not seriously considered. However, current conditions increase risk, and the intense media and legal interest have led to the issue becoming a major medical concern. Hospital-acquired infections can be considered from four angles: the clinical dimension is the most obvious. It involves hospitalized patients, and to an increasing degree, hospital staff; the economic impact although difficult to assess, is a largely underestimated drain on hospital budgets; the legal problems have been recently highlighted by developments in jurisprudence; finally, there are ethical considerations associated with the behaviour sometimes found among health care workers, as a consequence of workplace risks. In this article we try to define and assess the significance of the major factors. We discuss the validity of various epidemiological and economic tools, and thus highlight the role of hospital-acquired infections in the working of hospitals.

Cross Infection↗
PubMed1992

Influence of rural environment on diagnosis, treatment, and prognosis of colorectal cancer.

STUDY OBJECTIVE: Several studies have shown that residential location (urban or rural) influences the incidence of colorectal cancer. The aim was to investigate the influence of rural environment on colorectal cancer history and survival in a well defined population. DESIGN: Patients with colorectal cancer diagnosed in the department of Calvados (France) were classified by place of residence (urban/rural) and information on clinical symptoms, tumour extension, treatment, and survival was collected. SETTING: The study was population based, in the department of Calvados in France. PATIENTS: During 1978-1984, 1445 colorectal cancers were collected by the Digestive Tract Cancer Registry of Calvados, 1047 with an urban place of residence (544 males and 503 females) and 284 with a rural place of residence (134 males and 150 females). MEASUREMENTS AND MAIN RESULTS: In both sexes, rural patients with colorectal cancers were treated less frequently in a specialised health care centre (40.0%) than patients from an urban population (53.4%). The difference was mainly but not entirely explained by distance from the specialised health care centre. In females in the rural population, cancers were diagnosed more frequently at the stage of severe clinical symptoms (22.1%) and metastases (18.8%) than they were in the urban population (15.5% and 12.3%). In addition among females a rural environment appeared to confer a worse prognosis (relative risk = 1.3). CONCLUSIONS: Our findings suggest an inequality between rural and urban populations, especially for women. The loneliness of rural women leads to a delay in diagnosis and worse survival. In health education campaigns on colorectal cancer, efforts must be made to provide medical information to rural women in order to reduce the delay in diagnosis and improve survival.

Age Factors↗
PubMed1992

[Phenylketonuria: new questions for another generation].

Young women with phenylketonuria are at risk of bearing children with mental retardation. It results from the effects of the mother's elevated blood phenylalanine on the developing fetus. These effects may be prevented if a low phenylalanine diet is maintained prior to and throughout pregnancy.

Clinical Protocols↗
PubMed1991

[Resistance of hospital flora to imipenem. Experience in two intensive care units].

Imipenem is a beta-lactam antibiotic active against most Gram-negative bacilli. Between July 1, 1987 and September 30, 1989 (9 semesters), the activity of imipenem against 6 micro-organisms was tested in two intensive care units attached to the university hospital of Caen (Normandy). During the same period, the consumption of imipenem was evaluated from the number of vials drawn by each of these two units from the central pharmacy. Imipenem was found to be 100 percent effective against 5 of the 6 micro-organisms tested, but transient falls in sensitivity and an increase in imipenem consumption were observed when Pseudomonas aeruginosa was the pathogen. The most probable cause of these transient decreases of imipenem activity against Ps. aeruginosa was the existence of a resistant strain which showed a protein abnormality in its outer membrane by temporary selection pressure.

Acinetobacter↗
PubMed1991

Comparison of vaginal examination findings in two antenatal clinics.

Findings of routine vaginal examinations during pregnancy were compared in two teaching hospitals located in the same area of Paris. We selected 2943 women who had had at least one antenatal visit between 29 and 31 weeks of gestation. Large differences in the frequency of maturation signs were observed between the two hospitals for mid-position, soft consistency and expanded lower uterine segment, although the higher frequency of each sign was not found in the same hospital. No difference was observed for dilatation of the internal os. A better reliability in assessing dilatation than other signs of maturation may explain our results and the role of dilatation in the prediction of preterm delivery.

Adult↗
PubMed1991

Changing trends in preterm childbirth.

Progress in perinatal care has been accompanied recently by increasing numbers of induced premature deliveries because of fetal distress. This is confirmed by study of 26,796 consecutive births in the Caen Hospital Group between 1980 and 1987. Study of the fate of these children shows that this attitude has not led to any excess mortality when the share of the IPD before 32 weeks are regularly growing. This would imply that the prematurity rate is no longer a sufficiently accurate epidemiological index for the evaluation of prenatal care policies.

Female↗
PubMed1990

Prediction of preterm delivery: is it substantially improved by routine vaginal examinations?

The ability of routine vaginal examinations to improve the prediction of preterm delivery was assessed in a group of 6909 women who were registered at each prenatal visit and on whom this examination had been carried out. We compared two risk scores, one including known risk factors (maternal characteristics and symptoms reported by women), and the other including these factors and the findings of vaginal examination. These risk scores were computed by multiplying the adjusted odds ratio estimations obtained by logistic regressions. The prediction of preterm delivery was improved significantly by vaginal examination at 25 to 28 weeks' and 29 to 31 weeks' gestation. However, the improvement was not very large: when 30% of nulliparous women were classified as high risk at 29 to 31 weeks, the sensitivity was 55% when considering only the risk factors and 63% when adding the findings of vaginal examination; the percentages were 52% and 55%, respectively, for parous women. These results partially explain why the medical practice of routine vaginal examinations varies from country to country.

Adolescent↗
PubMed1990

Female urinary incontinence: comparative value of history and urodynamic investigations.

In order to identify the role of urodynamic investigation in relation to urinary symptoms, the authors assessed the diagnostic value of history and of urodynamic investigation in female urinary incontinence. 154 patients presenting with urinary incontinence were investigated prospectively, by standardised history and investigation of bladder stability and investigation of bladder stability and of cervico-urethral closure function. Clinical and urodynamic diagnostic conclusions were compared. Urodynamic results were highly discordant in the presence of clinical 'erethism', whilst agreement was more marked in the case of stress incontinence. Urodynamic investigation may be indicated after failure of medical treatment in the case of 'dysfunction'. By contrast, it is essential in stress incontinence in order to identify the mechanism or detect subclinical 'dysfunction'.

Female↗
PubMed1990

[Development of maternal milk flora during continuous enteral feeding of premature infants].

Unheated breast milk constitutes the main element in the premature infant's nutrition. However, it contains bacterial flora which is possibly responsible for infant pathologies. The authors find a considerable increase in the bacterial population during continuous drip-feeding of the premature infant. Aerobic flora present in the syringe are increased by 2.2 and coliforms by 28.5, sometimes resulting in highly contaminated milk at the end of the continuous drip-feeding period. To ensure bacteriological security a reduction in microbial count at the beginning of continuous enteral nutrition is necessary, without affecting the nutritive and immunological properties of breast milk.

Enteral Nutrition↗
PubMed1990

[Regionalization of health care and obstetric practice].

The decision to regionalize obstetric services in the Montreal metropolitan area was designed to improve the efficiency of the system. Changes in types of birth between 1981 and 1984 in this area were studied in order to evaluate the effects of this decision on cesarean section rates. Results show a sudden increase in cesarean rates, coinciding with the regionalization decision. Hypotheses put forward are linked to the characteristics of hospitals remaining after this measure, as well as the organisational disturbances which it may have caused.

Cesarean Section↗
PubMed1989

[Importance of the definition of urban zones in the study of cancer risk factors].

1446 cases of colorectal cancer have been collected in the Registry of digestive tract tumours in the "Department" of Calvados with the aim of studying the effect of residential location on cancer incidence. The risk-ratio was different in males and in females and between different types of urban areas. Using the urban category of "Zone de Peuplement Industriel ou Urbain" (ZPIU) increased the observed risk-ratio (1.6 for males, 1.2 for females), and enabled definition of homogeneous populations. This improved classification, thus allowed a more discriminating analysis of the effect of residential location on risk of cancer in both sexes.

Colorectal Neoplasms↗